1487699617 NPI number — JOHN LAWSON SURGICAL GROUP, PC

Table of content: DR. MADELINE ELIZABETH DAVIS MD (NPI 1376120196)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487699617 NPI number — JOHN LAWSON SURGICAL GROUP, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN LAWSON SURGICAL GROUP, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487699617
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 PROFESSIONAL PARK DRIVE
Provider Second Line Business Mailing Address:
SUITE 31
Provider Business Mailing Address City Name:
JOHNSON CITY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37604-6529
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-975-5650
Provider Business Mailing Address Fax Number:
423-975-5652

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 PROFESSIONAL PARK DR STE 31
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37604-6529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-975-5650
Provider Business Practice Location Address Fax Number:
423-975-5652
Provider Enumeration Date:
06/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OWENS
Authorized Official First Name:
MARGARET
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
423-975-5650

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3388129 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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